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Newborn Assesment

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NEWBORN ASSESSMENT
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  S.NO SPECIFIC OBJECTIVES TIME CONTENTS TEACHING/ LEARNING ACTIVITY A.V. AIDS EVALUATION 1. 2. 3. 4. Introduce the topic. Define the term of newborn. Explain the  purpose of assessment. Enlist the specific examination followed while examining newborn. 3min 2min 2min 4min INTRODUCTION - Monitoring of neonate is the keynote of to their successful outcome. Accurate observation is a vital factor in the survival and future development of the newborn. The initial physical examination should be  performed as soon as possible after birth. All newborn should be thoroughly examined in the first 24-48 hours of age. The nurse must understand the characteristics of the newborn to understand his status effectively. . DEFINITION:- A healthy infant born at term (between 38-42 weeks) should have an average birth weight for the country (usually exceeds 2500 gm.), cries immediately after birth, establishes independent rhythmic respiration & quickly adapts to the changed environment.   In India, the weight varies between 2.7-3.1 kg. with a mean of 2.9 kg. the length is 50-52 cm. PURPOSE OF ASSESSMENT - The overall purpose of newborn examination are to- 1.   Identify the physical and neurological characteristics of newborn. 2.   Identify and record evidence of common neonatal problems and congenital anomalies. 3.   Provide a basis for identification of needs and  plan nursing care of newborn. SPECIFIC INSTRUCTIONS - To perform thorough skilled examination of newborn, the following specific instructions should  be kept in mind. 1.   Observation should be made when the newborn is quiet and awake. Lecture cum discussion Lecture cun discussion Lecture cum discussion Lecture cum discussion lcd Black  board lcd Define the term of newborn? Who will explain the purpose of the assessment? Who will explain the specific instructions?   5. 6. 7. Described article required for examination of newborn. Enumerate various aspects of history related to newborn. Descibe the  physical assessment of 2min 4min 5min 2.   Ensure adequate light in examination room. 3.   The temperature of the examination room is maintained at 28+-2c. Avoid draft and chills in the examination room. 4.   Wash hands till elbow for 3min before and after handling the newborn. ARTICLES REQUIRED FOR EXAMINATION    –   1.   Weighing machine  –   to measure weight 2.   Measuring tape  –   to measure head circumference, chest circumference and abdominal girth 3.   Infantometer  –   to measure crown to heel length 4.   T.P.R. Tray  –   to check temperature 5.   Stethoscope  –   to auscultate heart rate 6.   Torch  –   to check papillary reflex and to observation oral cavity 7.   Record sheet  –   to record the findings GUIDELINES FOR ASSESSMENT- Examination of newborn includes reviewing history, measurements, general appearance, vital signs and head to toe assessment for identification of physical characteristics and deviations, if any. a)   Information related to previous pregnancy- gravida, para, abortions, number of alive children, still born.  b)   Information related to present pregnancy- EDD, registered, immunization, nutrition during pregnancy, any history of illness like PIH, eclampsia, anaemia, fever and DM c)   History of labour- presentation, duration of labour, rupture of membranes, method of delivery, medication during labour PHYSICAL ASSESSMENT OF THE NEWBORN - Physical assessment includes vital signs and head to Lecture cum discussion . Lecture cum discussion Lecture cum discussion lcd lcd lcd Which article used for examination? Enumerate various aspects of history related to newborn? Who will explain the assessment of   the newborn. toe examination. VITAL SIGNS - 1.   Respiratory rate (normal- 30-60 per min ) 2.   Heart rate- Apical rate (normal:120-160 per min) 3.   Temperature: either axillary or anal (normal axillary temperature 36.5-37.5c ,95.5-99.3f ) 4.   Weight: weigh newborn at the same time each time before feeding.( birth weight is 2500 gm) 5.   Place newborn on flat surface and extend legs fully before measuring to check length of the  baby. 6.   Measure around the fullest part of the occiput to check head circumference.( normal head circumference 33-35.5 cm ) 7.   Measure the chest circumference over the nipples and across the lower border of the scapula. (normal 31-33 cm ) DETAILED PHYSICAL ASSESSMENT - Head and face -   head size in proportion to body. -   Presence of moulding. -   Symmetry features Fontannels -   Anterior fontanels: diamond shaped 3-4 cm long, 2-3cm wide at 18 months. -   Posterior fontanels : triangle shaped, closed  by 8-12 weeks. -   Tense bulging fontanels indicate increase of intra cranial pressure -   Sunken fontanel indicate dehydration Eyes -   colour -   transient strabismus and nystagmus common in newborn -   doll’s eye phenomenon  the newborn?    Nose and mouth -   nasal patency -   mucous secretions, if excessive indicate tracheoesophageal fistula -    precocious teeth -   epstein’s pearl over the hard palate   Ears and neck -   ear pliability and flexibility -   low set ears indicate chromosomal or organ abnormality -   hearing -   neck size Chest -   contour and symmetry ( normally round and symmetrical ) -    breast engorgement may be evident 2-3 days after birth due to maternal hormone withdrawl -   respiration ( normally shallow, symmetrical, synchronous with abdominal movement) -    breath sounds ( crackles may be present during transitional period representing fetal lung fluid and areas of atelectasis.) -   rhonchi indicate fluid, mucus or meconium I the larger bronchi. -   Heart sound ( murmurs can be heard in case of improper closure of foramen ovale or ductus arterioles. Abdomen -   contour of abdomen ( normally round ) -   umbilical cord ( normally check for two arteries and one vein ) -   scaffold ( deflated ) sunken abdomen indicates diaphragmatic hernia. -   Bowel sounds ( normally audible when newborn is relaxed )
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